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Psych: Professor Julie Stout

Biography

Professor Julie Stout received an undergraduate degree from Ohio State University, and an M.A. and PhD from Duke University. She completed her post-doctoral training at the University of California, San Diego where she was a fellow in neuropsychology and neuroimaging. She is fully qualified as a clinical psychologist and neuropsychologist. Her clinical interests are in disorders of the brain’s frontal-striatal circuitry and dementias. 

Since relocating from the USA in July 2007, Julie has been based at the School of Psychology and Psychiatry Monash University, where she directs the Clinical and Cognitive Neuroscience laboratory and teaches into the clinical neuropsychology doctoral program and undergraduate psychology and behavioural neuroscience topics.

Professor Stouts research interests include understanding basal ganglia and frontal lobe functions in cognitive and affective processes, especially Huntington’s Disease, substance abuse, and Parkinson’s disease; application of mathematical models for studying constituent psychological processes embedded in complex behaviours; decision-making processes in people neurological disorders and substance abusers;  cognitive and personality features associated with damage to the brain’s frontal lobes or the associated subcortical brain circuitry; early detection in neurodegenerative diseases, especially Huntington’s Disease, focusing on cognitive and psychiatric changes; and evidence-based neuropsychological assessments.

Programme of Research

The Clinical and Cognitive Neuroscience Laboratory (the Stout Lab as it is known), was established within the School of Psychology and Psychiatry at Monash University in 2007.

Under the leadership of Professor Julie Stout, the Stout Lab, has two main areas of research: the development and implementation of strategies and tools for sensitive measurement of cognitive function to aid in the understanding and treatment of Huntington’s Disease; and cognitive modelling of decision making in substance abusers with the aim of understanding cognitive processing under risk and uncertainty and relating individual differences in these processes to drug use and treatment outcomes.

The main research approaches used include computerized cognitive, clinical neuropsychological, and neuropsychiatric assessment, along with mathematical modelling and neuroimaging (MRI, EEG). The aim is to link state-of-the-art research methods to clinical problems in ways that will help to understand heterogeneity among people with various disorders, and also in ways that have clear potential for affecting treatments. 

The Stout Lab is committed to finding treatments to enhance the quality of life of patients with Huntington’s Disease with the ultimate goal to prevent the development or slow the progression of HD.

Major Research Projects on Huntington’s Disease (HD)

Huntington disease is an autosomal dominant disease that typically shows onset in adulthood and individuals with the Huntington disease gene have a fifty percent probability of passing on the Huntington gene to each of their offspring. There has been a long line of research documenting the presence of Huntington-related symptoms prior to the onset of chorea. These symptoms, which encompass psychiatric, cognitive, motor, and other behavioural and personality disturbances have been reported retrospectively in many clinical studies. Prospective documentation for these symptoms, and a timeline that defines the onset and progression of symptoms prior to meeting the chorea-defined diagnosis, has been much more elusive.

Track-HD Project
This is a multi-centre, multi-national prospective, observational biomarker study of premanifest and early stage HD with no experimental treatment. Current sites are in Vancouver Canada, Leiden Netherlands, London, and Paris. It will be used to examine the sensitivity of individual and combined clinical and biological outcome measures for tracking progression of HD. The goal is to develop the much-needed methodology to undertake future clinical trials of disease-modifying agents in this group of HD patients. Cognitive aspects of this study are being monitored at Julie Stout’s Laboratory at Monash University.

The overall objective of the study is to find out what combination of measures is the most sensitive for detecting change over the natural course of HD, with a view to validating these measures for use in future therapeutic trials.

HD ToolKit Study
The HD Toolkit project seeks to identify a set of optimal tests and assays for use in clinical trials of compounds that have the potential to delay the onset and/or the progression of HD. As such, we believe this is an important step toward our ability to offer hope to those who are genetically predisposed to HD and their families. This study is currently being conducted at Julie Stout's Laboratory at Monash University.

The CHDI Cognitive Assessment Battery (CAB-Beta) Project
The CAB-Beta Project is a multi-site, international research project headed by Professor Stout.  The overall goal of the study is to develop a 60 minute series of tests (battery) that show both cognitive deficits in HD and pre-HD compared to controls, as well as the potential to show drug-induced improvements.

The study will evaluate a 90-120 minute test battery for use in late pre-diagnosis HD and early diagnosed HD. This battery will include tasks known to be sensitive in these populations (Core tests) as well as promising but understudied tasks (Provisional tests). Following analysis of the data, the battery will be pared down to a 60 minute battery of tasks with known sensitivity and test feasibility.

The intended use of final 60 minute test battery is in future clinical trials in late pre-diagnosis HD and early diagnosed HD.  CHDI’s goal is to develop disease modifying treatments. To accomplish this goal, for Phase 2 Proof of Concept studies, clinical endpoints will be needed that can measure symptomatic improvements over shorter periods. These clinical endpoints can then also serve as early indicators in Phase 3 trials. In addition, it is possible that treatments directed solely at improving cognitive function may be pursued.

Primary objectives for validation of the test battery include:

  • Characterization of the sensitivity of each task, exploration of composite scores for a subset or subsets of tasks. The characterization of sensitivity will allow us to pinpoint tasks that would eventually serve as treatment efficacy measures; and
  • Determination of feasibility/tolerability of the cognitive battery in late pre-diagnosis HD and early diagnosed HD.

Secondary objectives for the validation of the test battery

  • Characterization of test-retest reliability;
  • Determination of practice effects over clinical trial length retest intervals;
  • Assessment of alternate forms for repeated testing; and
  • Identification of individual tests that can serve as screens to identify subjects appropriate for inclusion in trials based on a certain level of cognitive impairment.

Major Research Projects on Substance Abuse

Substance abuse is a major health problem in Australia, characterised by continued substance use following negative consequences associated with use. Undoubtedly, this maladaptive behaviour arises from a complex interaction between socio-cultural and biological factors. 

Cognitive Models of Decision Making in Clinical Populations
The goal of this project is to develop and apply formal models of decision making to compare decision making in substance abusers.

Decision models allow the study of individual differences in cognitive and motivational processes of decision makers. The project’s specific aims include development and implementation of hierarchical Bayesian methods for comparing alternate decision models, parameter estimation, and tests of generalisation across decision tasks. These methods will be implemented in a decision making study of people with substance use problems. This research will yield new methods and a rigorous, theoretically-based account of how substance users differ from comparison subjects in their decision behaviour.

The project has three specific aims:

  1. To develop new hierarchical Bayesian model comparison procedures and then to test these new procedures against previous methods.
  2. To develop new hierarchical Bayesian parameter estimation procedures, and to evaluate the usefulness of these procedures in a comparison of the motivational, learning, and choice processes of people with and without substance use problems; and,
  3. To develop new tests of model generalisation based on hierarchical Bayesian analysis, and to apply these methods across a set of decision tasks to determine the limits of generalising across tasks.

Professional Activities

  • American Psychological Association (Division 40)
  • Association for Psychological Science
  • American Psychological Society
  • Australian Psychological Society
  • Cognitive Neuroscience Society
  • European Huntington Disease Network, Associate Member
  • Huntington Study Group
  • International Neuropsychological Society
  • Organization for Human Brain Mapping
  • Society for Neuroscience

Potential Student Projects

  • Effects of deep brain stimulation on cognition and neuropsychiatric symptoms in Parkinson’s disease
  • Apathy and impulsivity in moderate to severe Parkinson’s disease
  • Cognitive functioning and decision making in methodone maintained opiate users
  • Cognitive functioning and decision making in opiate users during withdrawal
  • Decision making and gambling among university students
  • Transcranial magnetic stimulation and cognition in Huntington’s disease and Parkinson’s disease.

Collaborations

  • Monash University - Associate Professor Nellie Georgiou-Karistianis
  • Indiana University-Professor Jerome Busemeyer
  • University College London-Professor Sarah Tabrizi
  • University of Manchester-Dr. David Craufurd

Grant Support

  • CHDI Foundation, Inc.
  • Australian Research Council
  • Australian National Health and Medical Research Council

Publications (2004-present)

2004

Stout, J.C., Busemeyer, J.R., Lin, A., Grant, S.J., Bonson, K.R. (2004). Cognitive modeling analysis of the decision-making processes used by cocaine abusers. Psychonomic Bulletin and Review, 11(4), 742-747.

Campbell, M.C., Stout, J.C., Finn, P.R. (2004). Reduced autonomic responsiveness to gambling task losses in Huntington’s Disease. Journal of the International Neuropsychological Society, 10(2), 239-245.

Blekher, T.M., Yee, R.D., Kirkwood, S.C., Hake, A.M., Stout, J.C., Weaver, M.R., Foroud, T.M. (2004). Oculomotor control in asymptomatic and recently diagnosed individuals with the genetic marker for Huntington Disease.  Vision Research, 44, 2729-2736.

2005

Wylie, S.A., Stout, J.C., Bashore, T.R. (2005). Activation of conflicting responses in Parkinson’s Disease: Evidence for degrading and facilitating effects on response time. Neuropsychologia, 43(7), 1033-1043.

Garavan, H., Stout, J.C. (2005). Neurocognitive insights into substance abuse. Trends in Cognitive Science, 9(4),195-201.

Yechiam, E., Stout, J.C., Busemeyer, J.R., Rock, S.L., Finn, P.R. (2005). Individual differences in the response to forgone payoffs: An examination of high functioning drug abusers. Journal of Behavioral Decision Making. 18, 97-110

Stout, J.C., Johnson, S.A. (2005). Cognitive impairment and dementia in basal ganglia disorders. Current Neurology and Neuroscience Reports, 5, 355-363.

Stout, J.C., Rock, S.L., Campbell, M.C., Busemeyer, J.R., Finn, P.R. (2005). Psychological processes underlying risky decisions in drug abusers. Psychology of Addictive Behaviors, 19, 148-157.

Yechiam, E., Busemeyer, J.R., Stout, J.C., Bechara, A. (2005). Using cognitive models to map relations between neuropsychological disorders and human decision making deficits. Psychological Science. 16(12), 973-978.

2006

Paulsen, J.S., Hayden, M., Stout, J.C., Langbehn, D.R., Aylward, E., Ross, C.A., Guttman, M., Nance, M., Kieburtz, K., Oakes, D., Shoulson, I., Kayson, E., Johnson, S.A., Penziner, E., and the Predict-HD Investigators of the Huntington Study Group (2006). Preparing for preventive clinical trials: The Predict-HD study. Archives of Neurology. 63, 883-890.

Blekher, T., Johnson, S.A., Marshall, J., White, K., Hui, S., Weaver, M., Gray, J., Yee, R., Stout, J.C., Beristain, X., Wojcieszek, J., Foroud, T. (2006) Saccades in presymptomatic and early stages of Huntington Diease Neurology, 67, 394-399.

Johnson, S.A., Yechiam, E., Murphy, R.M., Queller, S., Stout, J.C. (2006).  Motivational processes and autonomic responsively in Asperger’s Disorder:  Evidence from the Iowa gambling task. Journal of the International Neuropsychological Society, 12, 668-676.

2007

Marshall, J. White, K., Weaver, M., Wetherill, L.F., Hui, S., Stout, J.C., Johnson, S.A., Beristain, X., Gray, J., Wojcieszek, J., Foroud, T. (2007) Specific psychiatric manifestations among preclinical Huntington Disease mutation carriers. Archives of Neurology, 64, 116-121.

Solomon, A.C., Stout, J.C., Johnson, S.A., Langbehn, D.R., Aylward, E.H., Brandt, J., Ross, C.A., Beglinger, L., Hayden, M.R., Kieburtz, K., Kayson, E., Julian-Baros, E., Duff, K., Guttman, M., Nance, M., Oakes, D., Shoulson, I., Penziner, E. and the Predict-HD Investigators of the Huntington’s Study Group (2007). Verbal episodic memory function in individuals with the Huntington’s disease CAG-expansion: Cognitive symptoms are evident before clinical diagnosis. Neuropsychologia, 45, 1767-1776.

Yechiam, E., Veinott, E.S., Busemeyer, J.R., Stout, J.C.  (2007). Cognitive models for evaluating basic decision processes in clinical populations. In R. Neufeld (Ed.), Advances in clinical cognitive science: Formal modeling and assessment of processes and symptoms, 81-111. Washington, D.C.: APA Publications.

Georgiou-Karistianis, N., Sritharan, A., Farrow, M., Cunnington, R., Stout, J.C., Bradshaw, J., Churchyard, A., Brawn, T., Chau, P., Chiu, E., Thirnvady, D., Egan, G. (2007). Increased cortical recruitment during Simon task performance in Huntington’s disease. Neuropsychologia, 45, 1791-1800.

Johnson, S.J., Stout, J.C., Solomon, A.C., Cruce, C., Langbehn, D.R., Aylward, E., Queller, S., Ross, C.A., Kayson, E., Penziner, Beglinger, L., Duff, K., E., Nance, M., Hayden, M., Guttman, M., Shoulson, I., Kieburtz, K., Oakes, D., Paulsen, J.S., for the Predict-HD Investigators of the Huntington’s Study Group (2007). Beyond disgust: Impaired recognition of negative emotions in pre-diagnostic Huntington’s disease. Brain, 130, 1732-1744.

Duff, K., Paulsen, J.S., Beglinger, L.J., Langbehn, D.R., Stout, J.C. and the Predict-HD Investigators of the Huntington Study Group. (2007) Psychiatric symptoms in Huntington’s disease before diagnosis: The Predict-HD Study. Biological Psychiatry, 62, 1341-1346.

Stout, J.C. Weaver, M., Solomon, A.C., Queller, S., Johnson, S.A., Gray, J., Beristain, X., Wojcieszek, J., Foroud, T. (2007) Are cognitive changes progressive in prediagnosis Huntington’s disease? Cognitive and Behavioral Neurology, 20, 212-218.

2008

Paulsen, J.S, Langbehn, D.R., Stout, J.C., Aylward, E., Ross, C.A., Nance, M., Guttman, M., Johnson, S.A., MacDonald, M., Duff, K., Beglinger, L.J., Kayson, E., Kiebutz, K., Biglan, K., Shoulson, I., Oakes, D., Hayden, M., and the Predict-HD Investigators of the Huntington’s Study Group (2008). Detection of Huntington’s disease decades before diagnosis: The Predict HD study. Journal of Neurology, Neurosurgery & Psychiatry, 79 (8), 874-880.

Yechiam, E., Kanz, J.E., Bechara, A., Stout, J.C., Busemeyer, J.R., Altmaier, E.M., Paulsen, J.S. Neurocognitive deficits related to poor decision-making in people behind bars. (2008). Psychological Bulletin and Review, 15, 44-51

O’Donnell, B.F., Blekher, T., Weaver, M., White, K., Marshall, J., Beristain, X., Stout, J.C., Gray, J., Wojcieszek, J., Foroud, T. (2008). Visual perception in prediagnostic and early stage Huntington’s disease. Journal of the International Neuropsychological Society, 14, 446-453.

Ahn, W-Y., Busemeyer, J.R., Wagenmakers, E-J., Stout, J.C. (2008). Comparison of decision learning models using the generalization criterion method. Cognitive Science, 32(8), 1376-1402.

Beglinger, L.J., Paulsen, J.S., Watson, D.B., Wang, C., Duff, K.,  Langbehn, D.R., Moser, D. J., Paulson, H.L., Stout, J.C., Carlozzi, N.E., Queller, S., and the Predict-HD Investigators of the Huntington Study Group.(2008)  Obsessive and Compulsive Symptoms in Pre-Diagnosed Huntington’s Disease. The Journal of Clinical Psychiatry,69,1758-1765.

Solomon, A.C., Stout, J.C., Weaver, M., Queller, S., Tomusk, A.E., Whitlock, K.B., Hui, S., Jackson, J.G., Siemers, E.R., Beristain, X., Wojcieszek, J., Foroud, T. (2008) Ten year rate of longitudinal change in neurocognitive and motor function in prediagnosis Huntington disease. Movement Disorders,23,1830-1836.

2009

Bishara, A.J., Pleskac, T.J., Fridberg, D.J., Yechiam, E., Lucas, J., Busemeyer, J.R., Finn, P.R., Stout, J.C. (2009). Similar processes despite divergent behavior in two commonly used measures of risky decision-making. Journal of Behavioral Decision Making, 22,435-454.

Tabrizi, S.J., Langbehn, D.R., Leavitt, B.R., Roos, R.A.C., Durr, A., Craufurd, D., Kennard, C., Hicks, S.L., Fox, N.C., Scahill, R.I., Borowsky, B., Tobin, A.J, Rosas, H.D., Johnson, H., Reilmann, R., Landwehrmeyer, B., Stout, J.C., and the Track-HD Investigators. (2009). Biological and clinical manifestations of Huntington’s disease in the longitudinal Track-HD study: Cross sectional analysis of baseline data. Lancet Neurology, 8( 9), 791-801.

Blekher, T., Weaver, M.R., Marshall, J., Hui, S., Gray-Jackson, J., Stout, J.C., Beristain, X., Wojcieszek, J., Yee, R.D., Foroud, T.M. (2009). Visual scanning and cognitive performance in prediagnosticand early-stage Huntington’s disease. Movement Disorders, 24(4), 533-540.

Biglan, K.M., Ross, A.C., Langbehn, D.R., Aylward, E.H., Stout, J.C., Queller, S., Carlozzi, N.E., Duff, K., Beglinger, L.J., Paulsen, J.S., and the Predict-HD Investigators of the Huntington Study Group. (2009). Motor Abnormalities in premanifest persons with Huntington’s disease: The Predict-HD Study. Movement Disorders, 24(12), 1763-1772.

2010

Bishara, A.J., Kruschke, J.K., Stout, J.C., Bechara, A., McCabe, D.P., Busemeyer, J.R. (2010).  Sequential learning models for the Wisconsin card sort task: Assessing processes in substance dependent individuals. Journal of Mathematical Psychology, 54 (1), 5-13.

Fridberg, D.J., Queller, S. Ahn, W-Y, Kim, W., Bishara, A.J.,  Busemeyer, J.R., Porrino, L., Stout, J.C. (2010) Cognitive mechanisms underlying risky decision-making in chronic cannabis users. Journal of Mathematical Psychology, 54(1), 28-38.

Rowe, K.C., Paulsen, J.S., Langbehn, D.R., Duff, K, Beglinger, L.J., Wang, C., O’Rourke, J.F., Stout, J.C., Moser, D.J., and the Predict-HD Investigators of the Huntington Study Group. (2010). Self-Paced timing detects and tracks change in prodromal Huntington disease. Neuropsychology, 24 (4), 435-442.

Duff, K., Paulsen, J.S., Beglinger, L.J., Langbehn, D.R., Wang, C., Stout, J.C., Ross, C.A., Aylward, E., Carlozzi, N.E., Queller, S., and the Predict-HD Investigators of the Huntington Study Group. (2010). “Frontal” behaviors before the diagnosis Huntington’s disease and its relationship to markers of disease progression: Evidence of early lack of awareness.  Journal of Neuropsychiatry and Clinical Neurosciences, 22(2), 196-207.

Duff, K., Paulsen, J., Mills, J., Beglinger, L.J., Moser, D.J., Smith, M.M., Langbehn, D., Stout, J.C., Queller, S., Harrington, D.L.(2010). Mild cognitive impairment in pre-diagnosed Huntington disease. Neurology, 75, 500-507.

Oliva, J., Leung, S., Croft, R. J., O'neill, B., O’Kane, J., Stout, J.C, Luan Phan, K. & Nathan, P. J. (2010) The Loudness Dependence of the Auditory Evoked Potential is Insensitive to Acute Changes in Serotonergic and Noradrenergic Neurotransmission. Human Psychopharmacology: Clinical and Experimental, 25, 423-427.

Nguyen, L., Bradshaw, J.L., Stout, J.C., Croft, R.J., Georgiou-Karistianis, N., (2010). Electrophysiological measures as potential biomarkers in Huntington’s disease: Review and future directions. Brain Research Reviews, 64(1), 177-194.

Labuschagne, I., Phan, L., Wood, A., Angstadt, M., Chua, P., Heinrichs, M., Stout, J.C., Nathan, P.J. (2010) Oxytocin attenuates amygdala reactivity to fear in generalized social anxiety disorder. Neuropsychopharmacology, 35, 2403-2413.

2011

Upton, D.J., Bishara, A.J., Ahn, W-Y., Stout, J.C.  (2011). Impulsivity moderates the association between risky decision-making tasks”. Personality and Individual Differences, 50, 492-495.

Tabrizi, S.J., Reilmann, R., Durr, A., Roos, R.A.C., Leavitt, B.R., Jones, R., Landwehrmeyer, G.B., Fox, N.C., Johnson, H., Hicks, S.L., Kennard, C., Craufurd, D., Frost, C., Langbehn, D.R., Scahill, R.I., Stout, J.C. and Track-HD Investigators. (2011). Significant biological and clinical change detected over one year in premanifest and early stage Huntington’s disease in the Track-HD study. Lancet Neurology, 10, 31-42

Say, M. J., Jones, R., Scahill. R.I., Dumas, E.M., Coleman, A., Dar Santos, R., Justo, D., Campbell, J.C., Queller, S., Shores, E.A., Tabrizi, S.J., Stout, J.C. (2011). Visuomotor integration deficits precede clinical onset in Huntington’s disease. Neuropsychologia, 49(2), 264-270.

In Press

Stout, J.C., Paulsen, J.S., Queller, S., Solomon, A.C., Whitlock, K.B., Campbell, J.C., Carlozzi, N., Duff, K., Beglinger, L.J., Langbehn, D.R., Johnson, S.A., Biglan, K.M., Aylward, E.H., and the Predict-HD investigators and coordinators of the Huntington Study Group. Neurocognitive signs in prodromal Huntington disease. Neuropsychology.

Bechtel, N., Scahill, R. I., Rosas, H. D., Acharya, van den Bogaard, S.J.A., Jauffret, C., Say, M.J., Sturrock, A., Johnson, H., Onorato, C.E., Salat, D.H., Durr, A., Leavitt, B.R., Roos, R.A.C., Landwehrmeyer, B., Langbehn, D. R., Stout, J.C., Tabrizi, S.J., Reilmann, R. (2010). Tapping linked to function and structure in premanifest and symptomatic Huntington’s disease. Neurology.

O’Rourke, J., Beglinger, L., Mills, J., Moser, D.J., Rowe, K., Langbehn, D.R., Duff, K., Stout, J.C., Harrington, D., Carlozzi, N., Paulsen, J. (2010). The trail making test in prodromal Huntington disease: Contributions of disease progression to test performance. Journal of Clinical and Experimental Neuropsychology.

Dumas, E., van den Bogaard, S.J.A., Ruber, M., Reilmann, R., Stout, J.C., Craufurd, D., Hicks, S., Kennard, C., Tabrizi, S.J., van Buchem, M., van der Grond, J., Roos, R.A.C.(2010). Early changes in white matter pathways of the sensorimotor cortex in premanifest Huntington’s disease. Human Brain Mapping.

Under Review

Scahill, R.I., Hobbs, N.Z.,  Say, M.J., Bechtel, N., Henley, S.M.D., Hyare, H., Langbehn, D.R., Jones, R., Leavitt, B.R., Roos, R.A.S., Durr, A., Landwehrmeyer, B., Craufurd, D., Kennard, C., Hicks, S.L., Stout, J.C., Reilmann, R., Tabrizi, S.J., and the Track-HD Investigators. (2010). Correlations between structural loss and functional deficits in premanifest and early Huntington’s disease.  Cerebral Cortex.

Oliva ,J., Leung, S., Croft, R.J., O’Neill, B.V., Stout, J.C., Nathan, P.J. (2010).  A Gender Dichotomy of Serotonergic Transmission May Explain Inconsistencies in Loudness Dependence of the Auditory Evoked Potential (LDAEP) Literature in Humans.

Carlozzi, N., Stout, J.C., Mills, J., Duff, K., Beglinger, J., Whitlock, K., Solomon, A., Queller, S., Langbehn, D., Johnson, S., Aylward, E., Paulsen, J.(2010). Estimating premorbid IQ in the prodromal phase of aneurodegenerative disease. The Clinical Neuropsychologist.

van den Bogaard, S.J., Dumas, E.M., Milles, J.R., Craufurd, D., Stout, J.C., van der Grond, J., Roos, R.A.C., Reilmann, R., van Buchem, M.A. (2010). Magnetization transfer imaging in premanifest and manifest huntington’s disease. Neurology.

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